Tumor Necrosis Factor-Alpha Inhibitors: Oral Health and Orthodontic Considerations

Autoimmune diseases affect approximately 4.6% of the US population and are frequently managed with immunomodulatory therapies, including tumor necrosis factor-alpha (TNF-α) inhibitors. These biologic agents, such as infliximab, adalimumab, etanercept, golimumab, and certolizumab pegol, target TNF-α, a key cytokine involved in inflammatory signaling and bone remodeling. While TNF-α inhibitors have demonstrated efficacy in reducing disease activity across a range of autoimmune conditions, their impact on oral health and orthodontic treatment remains underexplored. Clinical studies suggest that TNF-α inhibitors can affect oral health, potentially altering risk of periodontitis, oral infections, and caries. TNF-α also plays a central role in orthodontic tooth movement (OTM), and animal studies suggest that TNF-α inhibition, whether local or systemic, can significantly reduce OTM and root resorption by suppressing osteoclast activity and altering cytokine signaling. This review synthesizes the clinical pharmacology of TNF-α inhibitors, current knowledge of their systemic and oral effects, and their potential influence on OTM.